Medicare price jump due to poorly supported Alzheimer's drug

Crushed

WASHINGTON (AP) — Medicare’s “Part B” outpatient premium will jump by $21.60 a month in 2022, one of the largest increases ever. Officials said Friday a new Alzheimer’s drug is responsible for about half of that.......

Medicare officials told reporters on Friday that about half the increase is due to contingency planning if the program ultimately has to cover Aduhelm, the new $56,000-a-year medication for Alzheimer’s disease from pharmaceutical company Biogen. The medication would add to the cost of outpatient coverage because it’s administered intravenously in a doctor’s office and paid for under Part B.

https://apnews.com/article/medicare-health-care-costs-medication-alzheimers-disease-health-27a6250da20a6ba6af4820525c64afc4

Michael Ellenbogen

I am pissed as my Medicare is going up because of the new AD drug and I don't even get to use it. There goes the 5.9 percent SSDI increase I received, not that it even cover the high cost. These people are killing us in so many ways and it is far from over.  People are really got to be hurting and so many more are gong to be if they are not already.  

Donr

That really makes me mad. Why would Medicare pay for such a drug.

Quilting brings calm

As we all know, the US is a very litigious country.  Medicare will eventually be sued if they don’t pay for it.  Although ( as we’ve discussed here), it should have never been approved by the FDA.  Way too many common severe side effects. 

I am surprised at this price jump being allowed.  I thought the price jump allowance was tied to the social security cola. How can the SS  go up 5.8% and the Medicare  jump be over twice that?  I read that the minimum SS check is less than $400.  This jump will exceed the SS Cola in actual dollars for them, not just percentages. In my Moms’ case, her net SS is $760 now.  This will take most of her Cola increase. 

FYI- my Moms’ meager SS check is one of the reasons I am delaying taking my own SS. I’m sure she took 1/2 of my step-dads rather than her own.   She took it at 63.  She’s 83 now.  What a horrible financial situation she is in.  

Crushed

Quilting brings calm wrote:

As we all know, the US is a very litigious country.

Actually we are less litigious than many other developed countries.  This is a meme sold by wrongdoers to escape liability Damages are larger in many cases since we have no social support for injured people.  Almost every in Germany carries legal insurance  so they can sue anyone. 

Medicare will eventually be sued if they don’t pay for it.  Although ( as we’ve discussed here), it should have never been approved by the FDA.  Way too many common severe side effects. 

This is not the same kind of litigation most people think of as "getting sued" 
 If medicare has a legal obligation to do something there may be an avenue for injunctive relief.  ( a court order)  Agencies are not afraid of such orders, they are a part of the regulator process both here and in other countries.

This was the precise area I taught for many  years.  This is a totally uncharted area since FDA did not make the usual findings of effectiveness.

  

  

Jo C.

. . . . and yet; something makes me look at the given reason for the price jump with a brow raised attitude and jaundiced eye . . . (along with my wonky knees does not make for a pretty picture) . . . somehow I feel this reason may possibly be a hook for them to hang their hats on as a reason for raising the costs for persons receiving SS and Part B benefits.  The  5.6% increase which was surprisingly high for SS, still did not reach the cost of living increase.

Each year, when SS benefits are increased, so are the costs for Part B; some years the increase equals the increase for Part B.  At least that is something.

Since that med is NOT considered a worthwhile endeavor, it is likely that many physicians will not be prescribing it. So, if not prescribed much at all; will the feds then lower the price jump?  I say this with tongue in cheek; that would never happen. 

We will never know with certainty the why's and wherefores for the actual and absolute truth for the price raise; pardon if I seem cynical; so much skulduggery goes on behind the scenes in all administrations; it is difficult to openly trust just what is what.

J.

Last Dance

 No matter how you cut it I think that some politicians are getting rich off this drug, they either own a lot of stock in this company or are getting some sort of kick back hence the high price increase. Also the present administration hasn’t a clue about what is going on in this country with inflation, and how it hurts  lower income families, and the democrat party itself  is hell bent to destroy the middle class, and replace it with their socialist ideology.

Paris20

When I read about this today, I wanted to scream. A drug that is basically useless but extremely expensive is going to raise our premiums. I understand that some want to make hollow promises to make us all feel better while dealing with an incurable disease but snake oil is probably a lot cheaper.

RobertsBrown

I'll bet the cost of this drug will really be hard on the French...no wait, I mean the Germans...nope, maybe the Russians?

Personally, I am honored to do my part to pay the executive bonuses at Biogen.

Edited:  I am losing my mind over this.  As a person who is in the process of losing everything to this stupid disease, it pushes ALL my buttons to read about huge money being demanded for what is probably a treatment of minimal value at best, cruel false hope at worst, and maybe the final assault on the remaining pennies of my fellow caregivers.

I also really regret that I didn't pay more attention to elder abuse until I was the elder being abused.

spitting nails.....

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dayn2nite2

I don't believe for a second that's the "reason" for the new premium.  That drug is widely panned and nobody's going to prescribe it anyway.

Raising the premium and using this drug as an excuse would be a great way to pay for other spending though, wouldn't it?

Crushed

dayn2nite2 wrote:

I don't believe for a second that's the "reason" for the new premium.  That drug is widely panned and nobody's going to prescribe it anyway.

Raising the premium and using this drug as an excuse would be a great way to pay for other spending though, wouldn't it?

Medicare premiums go in a trust fund.   "Part B, which covers physician visits, outpatient services, preventive services, and some home health visits, is financed primarily through a combination of general revenues (72% in 2019) and beneficiary premiums (27%). Beneficiaries with annual incomes over $85,000 per individual or $170,000 per couple pay a higher, income-related Part B premium reflecting a larger share of total Part B spending, ranging from 35% to 85%."  Now the Trust fund is audited periodically.

Crushed

Last Dance wrote:

 No matter how you cut it I think that some politicians are getting rich off this drug, they either own a lot of stock in this company or are getting some sort of kick back hence the high price increase. Also the present administration hasn’t a clue about what is going on in this country with inflation, and how it hurts  lower income families, and the democrat party itself  is hell bent to destroy the middle class, and replace it with their socialist ideology.

That pharmaceutical industry  contributes heavily to politicians who block the government from negotiating prices

 https://www.tampabay.com/news/health/2021/10/27/big-pharma-spends-big-to-block-attempts-to-control-drug-prices/

The Biden administration and Congress are embroiled in high-stakes haggling over what urgent priorities will make it into the ever-shrinking social spending bill. But for the pharmaceutical industry there is one agenda: Heading off Medicare drug price negotiation, which it considers an existential threat to its business model.   The siren call to contain rising drug costs helped catapult Democrats to power, and the idea is popular among voters regardless of their politics. Yet granting Medicare broad authority to intervene in setting prices has nonetheless divided the party.

And so, as it normally does, the drug industry gave generously to members of Congress, according to new data from KHN’s Pharma Cash to Congress database. Contributions covering the first half of this year show that some of its biggest donations were delivered with surgical-strike precision to sympathetic or moderate Democratic lawmakers the industry needs to remain in its corner.   Campaign donations to members of Congress — which must be reported to the Federal Election Commission — are the tip of the iceberg, signaling far greater activity in influence peddling that includes spending millions on lobbying activities and advertising campaigns.   Unusually, in the first half of this year Republicans and Democrats in Congress were virtually neck and neck in pulling in drug industry money, according to a KHN analysis of campaign contributions. In prior years, Republicans dominated giving from that sector, often by huge margins.

Pharmaceutical companies and their lobbying groups gave roughly $1.6 million to lawmakers during the first six months of 2021, with Republicans accepting $785,000 and Democrats $776,200, the Pharma Cash to Congress database shows. Since the 2008 cycle, the industry has generally favored Republicans. The exception was 2009-10, the last time Democrats controlled both chambers of Congress and the White House.   Democrats again narrowly hold both the House and Senate, and political scientists and other money-in-politics experts said the contributions likely reflect who is in power, which lawmakers face tougher reelection bids next year, and who has outsize sway over legislation affecting the industry’s bottom line.

Several pharmaceutical companies paused contributions to Republican lawmakers who voted against certifying the results of the 2020 election, blunting the GOP’s total fundraising haul and overall industry giving compared with other years.  The drug industry’s campaign contributions are markedly strategic, said Steven Billet, an associate professor at the Graduate School of Political Management at George Washington University.

Crushed

Last Dance wrote:

 No matter how you cut it I think that some politicians are getting rich off this drug, they either own a lot of stock in this company or are getting some sort of kick back hence the high price increase. Also the present administration hasn’t a clue about what is going on in this country with inflation, and how it hurts  lower income families, and the democrat party itself  is hell bent to destroy the middle class, and replace it with their socialist ideology.

Throw everybody out of work and prices come down

Employemnt is up  

THE EMPLOYMENT SITUATION — OCTOBER 2021

Total nonfarm payroll employment rose by 531,000 in October, and the unemployment rate edged down by 0.2 percentage point to 4.6 percent, the U.S. Bureau of Labor Statistics reported today. Job growth was widespread, with notable job gains in leisure and hospitality, in professional and business services, in manufacturing, and in transportation and warehousing. Employment in public education
declined over the month. 
  

U.S. economic performance under Democratic and Republican presidents

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Historically, the United States economy has performed better on average under the administration of Democratic presidents than Republican presidents since World War II. The reasons for this are debated, and the observation applies to economic variables including job creation, GDP growth, and stock market returns. The unemployment rate has fallen on average under Democratic presidents, while it has risen on average under Republican presidents. Budget deficits relative to the size of the economy were lower on average for Democratic presidents.[1][2] Ten of the 11 U.S. recessions between 1953 and 2020 began under Republican presidents.[3]

LadyTexan

I don't want to engage in the politics of this.

This disease has already wrecked us financially. I have accepted that our financial condition is less than what we saved and strived and planned to have at this time in our lives. I am relieved when I have enough to pay the monthly bills and keep a roof over our head. Right now, we have enough.

I struggle to stretch our limited dollars. My grocery bill has gone up every week for the past 6 weeks and I am buying the same things I bought 6 weeks ago. Each week the bill has gone up about $20. I am stretching our meals by adding beans and water. I am watering down the juice. We haven't eaten out in over a year. We don't order delivery or take out. I am definitely reducing the amount of detergent and paper towels I am using. I am only buying the essentials. I am not worried about the supply chain challenges delaying Christmas presents, because we are using our limited funds on groceries and medications, not gifts. 

It is sad and depressing. I am doing my best to make ends meet. It is stressful. I am grateful that today, we have enough.